Pyogenic Granuloma

Background

The pyogenic granuloma is a very common benign proliferation of capillary sized blood vessels. Its characteristic histologic appearance under the microscope leads to its other name, a lobular capillary hemangioma. This lesion are rapidly growing firm red papules that develop within weeks to months. The hands, face, and nasopharynx are favored locations. Disseminated cases may occur.

OUTLINE

Epidemiology

Disease Associations

Pathogenesis

Laboratory/Radiologic/
Other Diagnostic Testing

Gross Appearance and Clinical Variants

Histopathological Features and Variants

Special Stains/
Immunohistochemistry/
Electron Microscopy

Differential Diagnosis

Prognosis

Treatment

Commonly Used Terms

Internet Links

EPIDEMIOLOGY CHARACTERISTICS

SYNONYMS Lobular capillary hemangioma
Granulation tissue-like hemangioma

INCIDENCE Common

PATHOGENESIS CHARACTERIZATION

Trauma May precede some lesions

GROSS APPEARANCE/
CLINICAL VARIANTS CHARACTERIZATION

General

VARIANTS

Granuloma gravidarum Associated with pregnancy

Epulis gravidarum Pregnancy associated tumors arising within the mouth

Satellite lesions with recurrence Arch Dermatol 1974;109:689-691
Smaller papules surrounding the original site
Usually younger patients on the upper trunk or shoulder

HISTOLOGICAL TYPES CHARACTERIZATION

General
A lobular proliferation of capillary sized vessels, sometimes compartmentalized

Overlying epidermis may be ulcerated but if intact, may form distinct collarettes around the vascular proliferation-this epidermis may be derived from follicular and eccrine ductal epithelium

VARIANTS

Extramedullary hematopoiesis Am J Dermatopathol 2000;22:434-438
May be secondary to combination of homing and proliferation factors for stem cells

Extramedullary hematopoiesis in a pyogenic granuloma: a case report and review.

Vega Harring SM, Niyaz M, Okada S, Kudo M.

Department of Pathology, Tokyo Medical University, Tokyo, 160-8402, Japan.

J Cutan Pathol. 2004 Sep;31(8):555-7. Abstract quote

Background: Extramedullary hematopoiesis in the adult life is usually associated with hematological disorders. It can often occur in several organs under certain pathological conditions, including the spleen, liver, and skin, which are normal sites during the embryogenesis, the skin being very uncommon.

Case report: A case of extramedullary hematopoiesis in a granuloma pyogenicum at the anterior aspect of the right thigh of a 31-year-old Japanese man is reported.

Results: Histologic examination revealed an ulcerated polypoid lesion composed of numerous newly formed capillaries and a myxoid edematous stroma. In addition, three islands of hematopoietic precursors were found.

Conclusions: This is, to our knowledge, the second case of extramedullary hematopoiesis in a granuloma pyogenicum. We believe that vascular lesions have potential to generate hematopoietic precursor cells; however, hematopoiesis will only occur in a setting of adequate microenvironment, as it occurs in the bone marrow.

Intravenous
Am J Surg Pathol 1979;3:221-22

Subcutaneous Arch Dermatol 1982;118:30-33

DIFFERENTIAL DIAGNOSIS KEY DIFFERENTIATING FEATURES

Kaposi's sarcoma

Bacillary angiomatosis

PROGNOSIS AND TREATMENT CHARACTERIZATION

Treatment Surgical removal but many of these lesions regress spontaneously

Am J Surg Pathol 1980;4:470-479

Henry JB. Clinical Diagnosis and Management by Laboratory Methods. Twentieth Edition. WB Saunders. 2001.
Rosai J. Ackerman's Surgical Pathology. Ninth Edition. Mosby 2004.
Sternberg S. Diagnostic Surgical Pathology. Fourth Edition. Lipincott Williams and Wilkins 2004.
Robbins Pathologic Basis of Disease. Sixth Edition. WB Saunders 1999.
DeMay RM. The Art and Science of Cytopathology. Volume 1 and 2. ASCP Press. 1996.
Weedon D. Weedon's Skin Pathology Second Edition. Churchill Livingstone. 2002
Fitzpatrick's Dermatology in General Medicine. 5th Edition. McGraw-Hill. 1999.
Weiss SW and Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors. Fourth Edition. Mosby 2001.

Commonly Used Terms

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Last Updated 8/24/2004

Epidemiology
Disease Associations
Pathogenesis
Laboratory/Radiologic/ Other Diagnostic Testing
Gross Appearance and Clinical Variants
Histopathological Features and Variants
Special Stains/ Immunohistochemistry/ Electron Microscopy
Differential Diagnosis
Prognosis
Treatment
Commonly Used Terms
Internet Links

EPIDEMIOLOGY	CHARACTERISTICS
SYNONYMS	Lobular capillary hemangioma Granulation tissue-like hemangioma
INCIDENCE	Common

PATHOGENESIS	CHARACTERIZATION
Trauma	May precede some lesions

GROSS APPEARANCE/ CLINICAL VARIANTS	CHARACTERIZATION
General
VARIANTS
Granuloma gravidarum	Associated with pregnancy
Epulis gravidarum	Pregnancy associated tumors arising within the mouth
Satellite lesions with recurrence	Arch Dermatol 1974;109:689-691 Smaller papules surrounding the original site Usually younger patients on the upper trunk or shoulder

DIFFERENTIAL DIAGNOSIS	KEY DIFFERENTIATING FEATURES
Kaposi's sarcoma
Bacillary angiomatosis

PROGNOSIS AND TREATMENT	CHARACTERIZATION
Treatment	Surgical removal but many of these lesions regress spontaneously